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Pathophysiologic Implications

Gwenn S. Smith, PhD; Mony J. de Leon, EdD; Ajax E. George, MD; Alan Kluger, PhD; Nora D. Volkow, MD; Thomas McRae, MD; James Golomb, MD; Steven H. Ferris, PhD; Barry Reisberg, PhD; Joseph Ciaravino; Mary Ellen La Regina

Arch Neurol. 1992;49(11):1142-1150.

Abstract
• Positron emission tomographic studies of cerebral glucose metabolism have shown high diagnostic specificity in distinguishing among the degenerative dementias and differentiating between Alzheimer's disease (AD) and normal aging. The current investigation was undertaken to characterize the regional glucose metabolic deficits in AD, using cross-sectional and longitudinal study designs. All subjects met the National Institute of Neurological and Communicative Disorders and Stroke—Alzheimer's Disease and Related Disorders Association criteria for AD (n=45) or were normal (n=20), and the AD subjects were subdivided into incipient and mild AD and moderate plus moderately severe subgroups based on the Global Deterioration Scale. The subjects underwent a non—contrast computed tomographic scan and a positron emission tomographic (PETT VI) scan. The AD subjects (n=14) and normal control subjects (n=15) received evaluations 2 to 3 years after baseline study. The brain regions that show glucose metabolic deficits cross-sectionally (temporal and parietal association areas, with lesser degrees of deficit in subcortical gray matter structures), over the stages of AD, also show further deficits longitudinally within the same AD subjects. The reduction in glucose metabolism is greater than would be expected from the degree of brain atrophy. The glucose metabolic deficits are discussed in the context of neuropathologic findings and neurotransmitter deficits in AD.

Author Affiliations
From the Departments of Psychiatry (Dr Smith), Aging and Dementia Research Center (Drs de Leon, Kluger, Golomb, Ferris, Reisberg, Ciaravino, and La Regina), Radiology, Division of Neuroradiology (Dr George), Medicine, Division of Geriatrics (Dr McRae), and Neurology (Dr Golomb), New York (NY) University School of Medicine; and Department of Medicine, Brookhaven National Laboratory, Upton, NY (Dr Volkow).

Footnotes
Accepted for publication May 12, 1992.

Reprint requests to Department of Psychiatry, New York University School of Medicine, New Bellevue 12 WZ3, 550 First Ave, New York, NY 10016 (Dr Smith).

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